Despite the advances that have been made in the treatment of patients with pyoderma gangrenosum, we are still unclear as to the optimal way in which patients should be followed up once the diagnosis is made. The results of our study underline the importance of doing screening tests to detect potential disease, emphasizing patients younger than 50 years old, for a minimum time lapse of 24 months. It is essential to design randomized-controlled trials to understand the most appropriate and effective ways of following up patients with pyoderma gangrenosum.
Background: Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation p =0.025). Treatment of the underlying disease proved to be protective against mortality with an HR of 0.3 (95% CI 0.1 to 0.98, p = 0.046). Conclusions: The prognosis of HLH could be related to the treatment of the underlying disease. The study of the pathophysiology of this syndrome will allow a better understanding and treatment. (Rev Med Chile 2017; 145: 344-350)
Resumen:La hiponatremia asociada al uso de Ciclofosfamida es un efecto adverso infrecuente. Los estudios publicados no son concluyentes, especialmente respecto de los pacientes sometidos a dosis altas de dicho fármaco. Objetivos: Determinar la incidencia de hiponatremia en una subpoblación de pacientes que realizaron tratamiento con dosis altas de Ciclofosfamida. Materiales y Métodos: Estudio de cohorte retrospectivo de pacientes adultos que recibieron Ciclofosfamida a altas dosis en el período 2010-2014 en el Hospital Italiano de Buenos Aires. El evento primario fue la hiponatremia (definida como sodio plasmático menor a 135 meq/L) mientras que como eventos secundarios se tomaron la hiponatremia sintomática y la hiponatremia severa (valor menor 120 meq/L). Resultados: 96 pacientes recibieron altas dosis de Ciclofosfamida durante el período estudiado. Se excluyó un 27.4% de los pacientes por cumplir con los criterios de exclusión y se analizaron los datos de 69 pacientes. La edad media de la población fue de 56.5 años (DS 12.8) y un 37.7% de los pacientes eran mujeres. La incidencia de hiponatremia fue de 52% (IC95% 39-64), hiponatremia severa 5.8% (IC95% 0-12) y sintomática 8.7% (IC95% 1.3-16). La única variable asociada independientemente al desarrollo de hiponatremia fue el sexo femenino (OR: 3.89, IC95% 1.02-8.55, p=0.04). Si bien la incidencia observada resulta mayor a la observada en reportes previos, probablemente se deba a que solo consideramos la infusión de Ciclofosfamida a altas dosis. La hiponatremia severa y sintomática fue menor, aunque un 20% de los pacientes debieron prolongar su internación por esta causa.
Abstract:Cyclophosphamide-associated hyponatremia is an uncommon adverse effect. Published reports are inconclusive regarding patients under high-dose therapy. Objective: To determine the incidence of hyponatremia in patients under high-dose cyclophosphamide therapy. Methods: Retrospective cohort of adult patients who received high-dose cyclophosphamide therapy between 2010 and 2014 at the Hospital Italiano de Buenos Aires. The primary end-point was hyponatremia (defined as plasma sodium levels < 135 mEq/L), and secondary end-points were symptomatic hyponatremia, severe hyponatremia (plasma sodium levels < 120 mEq/L). Results: A total of 96 patients received high-dose cyclophosphamide therapy during the study period. 27 patients met exclusion criteria and accounted for 28.1% , so that 69 patients were included in the primary analysis. Study population mean age was 56.5 years (SD 12.8) and 37.6% were female. The cumulative incidence were as follows: 52% (CI 95% 39¬-64) for hiponatremia, 5.8% (CI 95% 0-12) for severe hyponatremia, and 8.7% (CI 95% 1.3-16) for symptomatic hyponatremia. The only independent variable associated with the development of hyponatremia was female gender (OR 3.89, CI 95% 1.02-8.55, p=0.04). Cumulative incidence found in this study appears higher than in previous reports, probably because only patients under high-dose cyclophosphamide therapy were included. Cumulative inc...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.